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Original Research Early Career Psychiatrists November 12, 2025

Prevalence and 3-Year Psychiatric and Mental Health Outcomes of Primary and Secondary Mood Disorders

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J Clin Psychiatry 2025;86(4):24m15765

Abstract

Background: Distinguishing between primary and secondary mood disorders (illness-or substance-induced) is important for appropriate treatment, yet their prevalence and outcomes in the general population remain understudied.

Aim: To compare psychiatric and mental health outcomes between primary and secondary mood disorders over a 3-year follow-up.

Methods: We used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of the US adult population (Wave 1, 2001–2002; Wave 2, 2004–2005). Primary and secondary mood disorders were assessed following DSM-IV criteria. Outcomes assessed 3 years later included recurrence and persistence of mood disorders, suicide attempt, mental and physical health–related quality of life, and mental health help-seeking behavior. All analyses were adjusted for a wide range of sociodemographic and clinical characteristics.

Results: Among 3,602 participants with mood disorders during the 12 months before Wave 1, 298 (8.3%) had secondary and 3,304 (91.7%) primary mood diagnoses. Following adjustments, secondary mood disorders were associated with significantly poorer physical health–related quality of life (β=−2.75; 95% CI, −4.27 to −1.23) and lower 3-year recurrence (adjusted odds ratio [AOR]=0.51; 95% CI, 0.36 to 0.72) and persistence rates (AOR=0.49; 95% CI, 0.31 to 0.79) compared to primary mood disorders. Other outcomes showed no significant differences (all P>.05).

Conclusion: Secondary mood disorders were not rare and associated with poorer physical health–related quality of life than primary mood disorders. However, both groups showed similar risks of suicide attempts, impaired mental health–related quality of life, and rates of mental health help-seeking behavior. The findings for adults with secondary mood disorders align with efforts to integrate physical and mental health care.

J Clin Psychiatry 2025;86(4):24m15765
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